Friday, November 02, 2012

CMS Issues Final 2013 Physician Fee Schedule Rule

On November 1, the Centers for
Medicare and Medicaid Services (CMS) released the final 2013 Medicare physician fee schedule rule, which sets the therapy cap amount on
outpatient therapy services for 2013 at $1,900; updates 2013 payment amounts
for physicians, physical therapists, and other health care professionals; and
revises other payment policies. The therapy cap exceptions process will expire
on December 31 unless Congress acts to extend it. Additional policies that will
impact physical therapists include implementation of new functional status
codes for reporting therapy services and updates to the Physician Quality Reporting
System (PQRS).

The final rule includes a 26.5%
across-the-board reduction to Medicare payment rates for physicians, physical
therapists, and other professionals due to the flawed sustainable growth rate
(SGR) formula. Since 2003, Congress had enacted legislation preventing the
reduction every year. CMS announces that it is "committed to fixing the
SGR update methodology and ensuring these payment cuts do not take effect."
Excluding the 26.5% projected SGR payment cut, the aggregate impact on payment
of changes in the rule for outpatient physical therapy is a positive 4% in
2013.

As required by the Middle Class Tax
Relief Jobs Creation Act of 2012, CMS will begin to collect data on claim forms
about patient functional status for patients receiving outpatient physical
therapy, speech therapy, and occupational therapy beginning January 1,
2013. Therapists will be required to report new G codes accompanied by
modifiers on the claim form that convey information about a patient's
functional limitations and goals at initial evaluation, every 10 visits, and at
discharge. This data is for informational purposes and not linked to
reimbursement. Until July 1, 2013, claims will be processed regardless of the
inclusion of functional limitation codes. Beginning July 1, 2013, all claims
must include the functional limitation codes in order to be paid by Medicare. APTA's
comments
on the proposed fee schedule rule had a significant impact in this area of the
final rule, which reflects many of the association's recommendations.

For 2013 the reporting period for
PQRS will be based on a 12-month reporting time frame. The bonus payment amount
will be .5%. Calendar year 2013 also will be used as the reporting period for
the 2015 PQRS payment adjustment of -1.5%. Successful reporting requirements for the program will remain as they
were in 2012, requiring that participants report a minimum of 3 individual
measures or 1 group measure via claims-based reporting on 50% or more of all
eligible Medicare patients, or report a minimum of 3 individual measures or 1
group measure via registry reporting on 80% or more of all eligible Medicare
patients.

The final rule
with comment period will appear in the November 16 Federal Register. APTA will post a detailed summary of the final
rule shortly.